NCQA Releases 2016 Health Insurance Plan Ratings

September 21, 2016 · NCQA Communications

NCQA is widely known for many things, like ensuring quality and equity in health care.

NCQA 2016-2017 Health Plan Ratings

But we’re also known for our annual health insurance plans ratings. NCQA rates more than 1,000 health plans based on performance and quality of care. We release them in September, ahead of open enrollment, to give consumers more information as they shop around for the best health plan.

These ratings provide consumers with a more accurate picture of how health insurance plans perform in the key quality areas of consumer satisfaction, prevention and treatment.

NCQA’s Health Insurance Plan Ratings 2016–2017 compare the quality and services of more than 1,000 health plans in the United States.

NCQA studied 1,401 health plans and rated 1,012: 503 private (commercial), 338 Medicare and 171 Medicaid. The ratings are a system similar to CMS Star Ratings of Medicare Advantage plans, and give unprecedented importance to health outcomes and consumer satisfaction.

Key Takeaways from the 2016–2017 Ratings Include:

• New England and Great Lakes Plans Perform Best: States with the highest percentage of plans receiving a 4.5 or 5.0 out of 5 rating include Massachusetts, Rhode Island, Wisconsin, Maine, New Hampshire, Minnesota, Vermont and New York. Hawaii and Iowa round up the top ten.
• High and Low Performers Are Rare: Of the 1,012 rated plans, 105 (10%) received a top rating of 4.5 or 5.0 out of 5. Twenty-seven (3%) earned the lowest ratings of 1.0 to 2.0. Most plans are in the middle, approximating a “bell curve” when all plans’ performances are plotted on a graph. http://bit.ly/1KsZIKi
• Commonalities among plans: The percent of top-rated plans are relatively the same between Private (Commercial), Medicare and Medicaid plans.

Ratings Focus on Satisfaction & Outcomes

The ratings consist of three major performance categories: consumer satisfaction, prevention and treatment.

• Consumer Satisfaction: What patients say about their health plans in satisfaction surveys, including care, customer service and physicians.
• Prevention: How well plans provide screenings, immunizations and other preventive services.
• Treatment: How well a plan performs in treating chronic and acute conditions such as diabetes, depression and heart disease.

In each category, the results—outcomes—of a patient’s care count extra in the scoring; for example, whether blood pressure and diabetics’ blood sugar are controlled to safe, recommended levels.
This emphasis on results means that, together with consumer satisfaction, outcomes are the main driver of ratings results.
NCQA’s Health Insurance Plan Ratings are available by visiting NCQA’s Health Plan Ratings Page.